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Medicare for All? 6 Big Questions Any Realistic Plan Must Answer

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By Michael Rainey

October 4, 2018

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“Medicare for All” has become a rallying cry for many progressive Democrats, and it’s a good bet that efforts to expand the popular insurance program will help shape the health care battleground over the next few years.

Paul N. Van de Water, a senior fellow at the Center on Budget and Policy Priorities, looked at the serious challenges that confront any effort to alter the Medicare program, which has been providing health care coverage for Americans 65 and older since 1965. Changing the program today will likely be far more complicated than establishing it ever was, Van de Water says, since the health care system is so much larger and more complex now, and millions of people have a stake in it, with groups of potential winners and losers hanging on every alteration.

Here are a few of the basic issues Van de Water examined that any Medicare expansion plan would have to address explicitly:

1. Eligibility. There are numerous proposals to change the eligibility age for Medicare, including a Republican plan to raise the eligibility age to 67 and a number of Democratic-backed plans that would lower the age to 62, 55 or 50. A universal Medicare plan would do away with eligibility thresholds entirely. This is one of the most basic questions any plan design must answer and carries enormous implications for cost and potential political support or opposition.

2. Generosity. Medicare is slightly less comprehensive than the employer-provided plans most Americans use for health insurance.Would this continue to be the case? Would an expanded Medicare be more generous than the current version, as Sen. Bernie Sanders’ plan calls for, or less so, in order to reduce costs?

3. Existing health care plans. What happens to existing health care plans -- including employer-provided plans, individual-market plans established by the Affordable Care Act, and Medicaid – as an expanded Medicare is rolled out? Would the country go through a phase with multiple options, or would some offerings be eliminated?

4. Provider payments and participation. Medicare pays less to medical service providers. How will they react? And what happens to the hundreds of thousands of workers in the current insurance system that stand to lose their jobs? Is worker retraining part of the plan, and the budget?

5. Costs and financing. How much will people pay for their coverage, and how much will be covered by the federal government?Will there be basic premiums for everyone? Subsidies?While a more rational health care system could indeed save money overall, there’s little doubt that taxes will have to be raised as the government plays a significantly bigger role in the health care system.

6. Transition. Any changes to the Medicare system need to be unrolled precisely in a pre-determined time frame that would require considerable advanced planning. Program changes of this size tend to be phased in, but the exact schedule would need to be determined well ahead of time, with full awareness that things may not go smoothly, particularly early on.

Click here for Van de Water’s full review, which reviews even more potential hurdles facing any effort to alter the current Medicare system.